The amygdalotomies unfortunately did not work. After three years,
dozens of rage seizures, and a violent assault on a nurse, surgeons will
try again to kill -- by cutting out a small part of Matthew's abnormal
brain -- about a square centimeter of it. He'll have a cingulotomy: an
operation designed to dampen motivation, to calm. It is also performed
for cancer pain that even narcotics can't help. "I did one on a
bone-cancer patient," said the surgeon. "Before the operation he cried in
agony all day. After, he was completely relaxed. He read most of the
time. He had no more suffering. He had no more emotions, either, nor was
he capable of any real mental work. It was drastic. Like a lobotomy.
Matthew's will not be that drastic."
Drastic or not, there is nothing left to try. "This kid's brain is
totally out of control," says a child neurologist who consulted on
Matthew's condition. "When the amygdalotomies failed, his own neurologist
wept. He said he didn't know how to face the family. He cried, really
cried. There's nothing left now but high-security institutionalization
and sedation to the point of near coma. The new surgery is a chance. It's
a Hobson's choice for us all," the neurologist added. "Even if it stops
the violent rages, we don't know if it will stop the obsessive
behavior."
* * * *
7:15 A.M. In the wide corridor of the medical center's basement
neuroradiology suite, Matthew waits on a gurney, held securely in four
point restraints. With him are his mother, older brother Jim, and a guard
from the state mental hospital. In anticipation of his cingulotomy, he
had been transferred from the high-security, prison-style hospital; there
is hope that if the surgery succeeds, the halfway house, sheltered
workshop training, and independence await. Matthew is nervous but
cheerful, wrapped in pastel gowns, his feet and legs in vented stockings,
IV line taped securely to his right arm. "I'm not getting my hopes too
high this time," his mother says, her eyes on Matthew. "I am," his father
says. Matthew is quiet.
Matthew's surgeon walks by in a three-piece suit he'll soon
exchange for pale green scrubs. He stops for a minute to talk, holding on
all the while to his briefcase. He pats Matthew's foot. "I'll see you
soon," he says.
Matthew's family will see neither their son nor the surgeon for the
next nine hours.
* * * *
Operating suite 2 really is a suite. The largest of the rooms is
the operating room itself; unlike conventional ORs, it houses a modern CT
scanner, with its hollow-scooped bed and donut-shaped scanning apparatus.
Five freestanding monitors are on site as well, to track drugs and vital
signs. Behind the scanner, Vincent Lerie, a radiation technician, and
Gerry Beveringen, a scrub nurse, set up three sterile tables for
equipment.
Most prominent alongside the usual scissors, knives, sutures, gauze
pads, needles, and tubes are the Radio Frequency Lesion Generator and the
stereotactic halo. This circular frame holds the patient's head in a
fixed position and guarantees millimeter-precise positioning of the brain
probe and needle tip that the Lesion Generator will heat to 75 degrees
Centigrade. Over the next few hours, Lerie will switch it on 10 separate
times to destroy 10 tiny pieces of brain tissue in Matthew's cingulate
gyrus, deep in the temporal lobes beneath his cerebral cortex.
The cingulum itself is part of the limbic system (or "primitive"
emotional brain) that carries signal-making nerve fibers around the
system -- including the signals that trigger Matthew's rage-producing
seizures. The heated needle will create dead space to act as "firebreaks"
in Matthew's brain and hopefully stop transmission of these
rage-triggering signals. The stereotactic equipment eliminates the risk
of "blind" freehand reaches into the limbic system by automatically
lining up points on the computer to make a topographic map of Matthew's
brain.
The CT roadmaps guide the surgical probes safely past areas of the
cerebral cortex that control sensory and motor functions (including smell
and sight, and arm and leg movement) and safely away from the thalamus
that is the main relay station taking messages to the higher centers of
the cortex.
To compare this cingulotomy to old prefrontal lobotomies is like
comparing a Civil War conscript's musket fire to the launch of a Tomahawk
missile. The lesions to be made in Matthew's cingulum are anatomically
"miles" from the frontal lobe, but the changes -- the calming, flattening --
they produce will be somewhat similar. That's because the neural fiber
pathways work in parallel and bundle together in various spots deep in
the brain. Thousands of psychosurgeries, along with modern technology
have brought less of the knife and enough of the desired effect, without
the mutilating damage of frontal lobotomy.
Space is crowded in the suite, especially with plans for a
half-dozen or more onlookers: radiologists, students, physician
assistants. A glass-walled anteroom faces the OR and contains four
computer monitors and other equipment. All of it will be used to display
and interpret scanner information and pinpoint targets for the team that
has planned this sortie into Matthew's limbic system like a military
operation.
An adjacent small room holds the computer that operates the
scanner, and connecting the areas is a small corridor and cul-de-sac
enclosing a "light wall" to read the pictures made of the scans. It also
houses a 30-cup, ever-filled coffeepot.
Tags:
bad reputation,
belief,
brain surgery,
dilemma,
horizon,
human brain,
human subjects,
lobotomy,
mental illness,
nam,
neurology,
philosophers,
pretension,
psychiatric disorders,
psychosurgery,
record keeping,
safeguards,
scientists,
strict regulations,
successes,
surgery,
worth the risk,
wretched excess
